Enrollment Form

NY Center for Autism Treatment

Wonder. Learn. Grow.

Enrollment Process

Our specialist will contact you

Call us: 718-484-9219

Fax: 347-412-6028

Address *

Child's Date of Birth:

Email: *

Check here to receive email updates

Insurance Carrier: *

Desired in-home ABA schedule (e.g. M-F 3:00pm-6:00pm & Saturday 10:00am-12:00pm):

Parent Name: *

Does your child have a current Autism diagnosis?

Phone *

Child's Name: *

Child's Member ID:

Primary language spoken at home:

Areas of concern:

What to expect when getting started
Obtain an autism spectrum diagnosis by a medical doctor. This is required for all health insurance companies.
Complete this intake form.
Schedule your individualized assessment.
Get started with your team consisting of a Board Certified Behavior Analyst and ABA therapist(s).
Complete parent training and coordination of care with the school services providers to ensure steady acquisition of treatment plan goals.